What can we learn from the Right to Control?

The Right to Control was a new rights-based approach to support and services for disabled people. It brought together a range of government funding streams across social care, housing and employment with a view to improving people’s experiences across these funding streams and, ultimately, improving people’s lives.

I write about it in the past tense because the Right to Control is no more. The pilot ran for two years from December 2009 with a further extension until the end of December 2012. A Ministerial decision in 2014, however, decided not to roll-out the Right to Control any further.

The decision was based in large part on the findings of a formal evaluation (pdf). This

did not find any evidence of the Right to Control having a positive impact on customers, either in terms of their experiences of applying for and organising support or services, or in terms of their day-to-day lives, including employment outcomes.

The evaluation notes, however, this lack of evidence is most likely due to the fact people did “not experience the intended Right to Control customer journey” and that the short space of time for which the pilots existed may not have been sufficient for the full effects of Right to Control to be felt.

What was unique about the Right to Control, compared to pilots regarding Individual Budgets (as were) and Personal Health Budgets (as are) was its attempt to unify – to integrate – funding streams around an individual. It was therefore similar to parts of what the Integrated Personal Commissioning programme is seeking to achieve.

The question is this: What can we learn from the Right to Control? From my reading of the evaluation, other documentation available around the Right to Control, and from conversations with colleagues who were heavily involved in several of the pilot areas, I would suggest eight (by no means comprehensive) things we can learn*.

1. Create demand from the bottom-up by building the understanding and expectations of people who could benefit from the change. There is no point having new rights or the potential for more choice and control if the people these are intended to benefit aren’t aware of them or equipped to expect them. This isn’t just limited to people who use services, either: carers and staff are also important to focus on. For example, employment support in a northern pilot area worked so well under the Right to Control because there were two Disability Employment Advisors who were looking for a way to change a system they saw every day wasn’t working for the people they supported. The Right to Control gave them a vehicle to change things.

2. To build meaningful demand, market development must start as soon as possible. The Right to Control evaluation notes the following specific conditions needed to be in place: (1) People were aware they could request changes; (2) People had information and advice to make confident choices; (3) People had meaningful choices. The first two are extensions of my first point. The third – meaningful choice – is facilitated by two vital, complementary process: (1) coordinated care and support planning, and (2) market development. I’ll deal with coordinated care and support planning in a separate post. On market development, the most important lesson from the Right to Control is that market development didn’t start soon enough. It takes time to start, (re)negotiate or end contracts and agreements with providers of all sizes, to inform and work with them of the types of changes anticipated, to keep people and staff up-to-date on changes to the local ‘market’, and all the other similar activities that make for successful market development. Start early on market development, and be proactive about it.

3. The third lesson is no surprise at all: change on this scale takes time. By “change” I mean both practical and cultural change. Practically, for example, it took around twelve months in most of the Right to Control pilot sites just to get the right people around the table and to start having the right kinds of conversations. Where most good progress was made was for people with mental health problems accessing employment support. The reason for this was because the then Community Mental Health Teams became the most common entry points into the Right to Control because of greater partnership working that had existing from before the Right to Control pilot started. Of course, change taking time is no great lesson, but it is one that bears repetition, especially when the current demands on public services in health and social care are so pronounced, and when numbers are seemingly the only way we can convince people of progress.

4. One of the biggest cultural barriers in the Right to Control is represented by the question: “Whose money is it anyway?” Reasonably often, local managers referred to budgets as “their money”, resulting in difficulties in pooling budgets or integrating them around individuals. It’s actually a very good question, and surfacing these types of questions and discussing them was seen to help progress towards the Right to Control’s aims.

5. User responses to the question of “whose money is it anyway?” are probably best captured by this paraphrase:

We don’t give a toss where the money comes from – we just want a life.

What enabled this voice to be heard was co-production of the Right to Control. Co-production itself was therefore a major driver in changing attitudes, which helped to create confidence, support and a shift in relationships and mindsets between “professionals” and “people”. (It’s worth noting the formal evaluation concluded co-production would last well beyond the life of the Right to Control pilots themselves – a point proven so far, writing from the distance of 18 months since the programme finished.)

The last three lessons from the Right to Control are strategic ones that should be cause for reflection at higher levels in local government, health bodies and central government.

6. The first is to recognise that funding streams need to be integrated locally because they are separated centrally, i.e. government is asking local areas to merge budgets that they themselves had split up in the first place. As a participant in the evaluation ruefully notes:

What we need to do is look at pooling budgets at a much higher strategic level. It’s very difficult to align funding streams once the money is allocated, if not impossible, so hence the focus on pooling budgets at a much higher level, to have the one-pot approach.

Anything that central agencies can do to integrate funding as soon as possible should be done is the lesson to take from this.

7. The second is to be consistent in the intentions and outcomes of the programme. The Right to Control started as a new legal right to support disabled people to have better lives; it ended (via the evaluation) with a decision that questioned its economic efficiency and impact on primarily social care measurements. What if the evaluation had captured stories from two sites about people with learning disabilities signing housing tenancies for the first time, or fifty people gaining employment because of direct control over funding they never knew was previously spent on them?

8. This links to the final lesson: the Right to Control didn’t connect politically at either a local or national level. The Right to Control squarely support two significant agendas that have existed since 2008 – prevailing attitudes to public services (the idea of empowered consumers) and the zeitgeist of austerity (more for less) – and yet remained unloved, to the point where it was ended and largely forgotten. Reflecting on why it didn’t connect and the roles that different people/organisations could have played in addressing is useful for any current or future change programme.

There are many other areas of learning that can be drawn from what the Right to Control did and didn’t achieve during its time. In the ones above I’ve drawn out the ones that seem most relevant to me for current and future public service reforms, not least of which is Integrated Personal Commissioning and what it seeks to achieve.

*I should note that I was involved in the Essex Right to Control Trailblazer.

When was the last time you changed your mind about something important?

Rodin's ThinkerThis question popped into my head the other day: when did I last change my mind about something important? It was prompted by a conversation with friends on Twitter about whether direct action was a useful form of campaigning, and over time I realised I’d been a bit too dogmatic about my views on this in the past.

I changed my mind.

What this made me wonder, though, was the process by which I came to change my mind: how did this happen? What was most effective? Who did the alternative messages come from? What information had I seen etc.

For those of us interested in change (including public sector reform), the ability to understand persuasion and the reasons why people change their minds should be absolutely uppermost in our minds. Yet I don’t think I can actually recall a time when the psychology of changing your mind has been talked about at events or conferences.

Going back through some of this literature in order to understand and then apply it seems useful to me. I’d be grateful for any pointers people have.

In the meantime, some writing on this that I’ve found of interest:

Systems Leadership in practice

I was kindly invited by Debbie Sorkin to attend an event on Systems Leadership last week. It was held at the University of West of England’s business school, and was part peer support, part theory and part sharing findings on how Systems Leadership works in practice.

I’ve highlighted before why I’m so taken with what Systems Leadership seeks to do – see here and here – and it was great to hear directly from people who have been explicitly putting this approach into practice through the Local Vision programme.

The Local Vision programme is run by the Leadership Programme and supports 25 areas with Systems Leadership at the moment. An interim evaluation (pdf) of how this has been working so far is now available, and there’s lots of good stuff in there to look at and consider. I’m particularly taken with the importance of the Enabler role – a person who:

  • Builds a safe space, relationships and trust
  • Surfaces hidden themes and patterns
  • Fosters recognition and ownership of what needs to change
  • Creates shared purpose and collective connection
  • Explores and fosters recognition of the nature of systems leadership
  • Brokers/acts as independent arbiter; encouraging reflection and learning.

As if to highlight this is a way of working that deserves more attention, the King’s Fund also last week published a fascinating report about the practice of Systems Leadership and “being comfortable with chaos”.

One final point: it was rightly noted at the UWE event that Systems Leadership isn’t the only answer. I agree wholeheartedly with this: we cannot and should not dogmatically take a Systems Leadership approach to every problem we face, if not for the sole reason that not every problem will be suited to such an approach.

Empowerment in the US Navy!

USS Santa Fe

You can’t implement a bottom-up concept in a top-down way.

Empowerment is just some wishy-washy claptrap that managers use to carry on exerting their own power, isn’t it?

Well, yes, it is – if folks don’t really understand empowerment. But folks who get empowerment know and feel a different version.

I’ve most often read about this different version in public services like health and social care. So reading this take on empowerment in, erm, the US Navy was exhilarating!

There’s lot in there to think and reflect on, but here are a couple of choice snippets:

Saying we need an empowerment program is like saying we need a swimming program. The implication is that swimming isn’t a natural occurring behavior for our people. So, what we are saying when we say we need an empowerment program is that the fundamental way we run our organization is dis-empowering.

and

If it takes the boss to empower them, the boss can unempower them, and that’s not very powerful.

If it can work in the US Navy, e.g.

The highest performing teams in the military perform in highly decentralized, and empowered ways.

… then I’m pretty sure it can work in health and social care (and public service management more generally).

Right now, is left wrong and right right?

Matthew Taylor on the left:

The nature of power is shifting yet social democratic organisations continue too often to exemplify a model of hierarchical bureaucracy, tending to see power as a zero-sum quantity won or lost internally in factional battles and externally in elections.

But power is dynamic, fluid and positive sum (the same team of people can be powerless or powerful depending on how they work together). It can be generated – in whatever circumstances – through creativity, collaboration, integrity and generosity. The phrase  ‘in’ or ‘out of power’ may refer to control of the Government but it also speaks to a more fundamental problem with how the leadership cadre of social democratic parties think about change.

David Brooks on the right:

The most surprising event of this political era is what hasn’t happened. The world has not turned left. Given the financial crisis, widening inequality, the unpopularity of the right’s stances on social issues and immigration, you would have thought that progressive parties would be cruising from win to win.

But, instead, right-leaning parties are doing well [because]… they have loudly (and sometimes offensively) championed national identity[,] they have been basically sensible on fiscal policy… [and their] leaders did not overread their mandate.

Pace of change in the US

Here is a terrific visualisation of the pace of change in the US on issues such as interracial marriage, prohibition, abortion and same-sex marriage. Pace of social change in US If this is your sort of thing then you’ll definitely be interested in Chris Hatton’s post on the conditions for change in public policy, plus a collection of links I’ve brought together on change across systems and within organisations.

Even in 2015, disabled people still disproportionately excluded from the internet

Source: Office for National Statistics
Source: Office for National Statistics (pdf)

Here at arbitrary constant we have previously been interested in internet usage statistics, particularly when it comes to disabled people. In June 2012 we reflected that half of all people who have never used the internet are disabled people. Where are we now?

The latest ONS internet usage statistics are out, and things look like they’ve only moderately moved in a positive direction for disabled people.

Overall, the number of people using the internet continues to increase: 85% of all adults had used the internet in the last three months (to March 2015), an increase of 1% since last quarter.

Some 11% of adults (5.9m people) have never used the internet (to March 2015). This is a reduction of 6% since March 2011, which remains encouraging.

Of these 5.9 million adults who had never used the internet, 3.0 million were aged 75 years and over. This represents 33% of people aged over 75. Similarly, 3.3 million disabled adults had never used the internet, which represents 27% of disabled adults.

In June 2012, 34% of people over 75 and 34% of disabled adults hadn’t used the internet. Thus, there has been a 4% and 7% increase in the number of people over 75 and disabled people using the internet respectively. Nevertheless, it remains the case that over half of all the people who have never used the internet are disabled people.

This is made clear in graph at the top of this post, which shows the proportion of non-internet users depending on whether they’re a disabled person or not over the last two years. Thus, whilst things are moving in the right direction, and consistently with, say, people aged over 75, disabled people are still disproportionately failing to reap the benefits of the internet, even in 2015.